Brave Explorers Camp & Selective Mutism Clinical Treatment Interest Form Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### How did you hear about us? What services are you interested in? * Enrolling my child in Brave Explorers Camp Ongoing Treatment with Brave Seattle other (please share more below) Child's name Child's age My child has a diagnosis of selective mutism already * yes no Anything else you would like us to know? * Thank you!
